Behav Analysis Practice (2014) 7:7077
DOI 10.1007/s40617-014-0011-6
EMPIRICAL REPORT
Barriers to Independent Living for Individuals
with Disabilities and Seniors
Florence D. DiGennaro Reed & Michael C. Strouse &
Sarah R. Jenkins & Jamie Price & Amy J. Henley &
Jason M. Hirst
Published online: 11 June 2014
# Association for Behavior Analysis International 2014
Abstract Individuals with disabilities and seniors often lack
the freedom to choose with whom they live and where they
reside. Service options may involve moving consumers to
large nursing facilities or other less-preferred settings rather
than optimizing environmental supports in their own home or
in less restrictive settings. Not only do adults usually enjoy
greater choice when they live in their own homes relative to
individuals living in congregate care or group home settings
but independent and semi-independent settings are also asso-
ciated with better outcomes and lower costs. Identifying var-
iables that serve as barriers to independent living is especially
important given estimates predicting that the numbers of
seniors and individuals with disabilities will double in the
next 20 years. This doubling will tax an already burdened
and costly system of care. The present study queried
consumers and other key stakeholders about potential
barriers to independent living and their importance.
Findings not only revealed a high degree of overlap
between identified barriers and their importance ratings
within groups but also showed clear differences in potential
barriers across the groups assessed (individuals with disabilities
and senior citizens).
Keywords Independent living . Disabilities . Senior citizens
F. D. DiGennaro Reed (*) : S. R. Jenkins : A. J. Henley :
J. M. Hirst
Department of Applied Behavioral Science, University of Kansas,
4056 Dole Human Development Center, 1000 Sunnyside Avenue,
Lawrence, KS 66045-7555, USA
e-mail: fdreed@ku.edu
M. C. Strouse : J. Price
Community Living Opportunities, Inc, Lawrence, KS, USA
Barriers to Independent Living for Individuals
with Disabilities and Seniors
The numbers of seniors and individuals with disabilities are
expected to double in the next 20 years (Harrington et al.
2002) with estimates predicting that 20 % of the US popula-
tion will be 65 years or older by 2030 (Jungers 2010; LeBlanc
et al. 2012). As the baby boomer generation ages, barriers to
an already taxed system will emerge and prevent individuals
from accessing needed support. Unfortunately, barriers to
service provision presently exist and result in service delays
for those most in need of care. Long wait lists, a lack of
legislative support, and a limited number of skilled providers
prevent consumers from receiving the care and support they
need (Harrington et al. 2002; LeBlanc et al. 2012). Moreover,
the costs are staggering; both in-home and out-of-home ser-
vices are associated with high societal and individual financial
costs (Centers for Medicare and Medicaid Services [CMS],
2010). For example, individuals living in nursing home facil-
ities pay, on average, $50,000 annually. Estimates indicate that
state insurance programs, such as Medicare and Medicaid,
spent $143.1 billion for nursing care facilities in 2010 and
$128.5 billion for residential and other health-related expenses
(CMS, 2010). Many individuals and insurance companies
simply cannot afford the services that are needed and/or
desired.
Despite federal legislation (e.g., Developmental Disabil-
ities Assistance and Bill of Rights Act of 2000, P.L. 106
402) and other important advances of the independent living
movementwhich emphasize empowerment of consumers in
their own life decisions (Frieden 1980)individuals with
disabilities and seniors often lack the freedom to choose with
whom they live and where they reside (Stancliffe et al. 2011).
Service options may include moving consumers against their
desire to large nursing facilities or other less-preferred settings
rather than optimizing environmental supports in their own
Behav Analysis Practice (2014) 7:7077
home or in less restrictive settings. Not only do adults enjoy
greater choice when they live in their own homes relative to
individuals living in congregate care or group home settings
(Stancliffe et al. 2011) but independent and semi-independent
settings are also associated with better outcomes and lower
costs (Burchard et al. 1991; Stancliffe et al. 2011; Stancliffe
and Keane 2000). To address the growing demand for quality
services provided in a manner desired by consumers, national
leaders and public policy advocates are searching for ways to
provide affordable services (Bowes and McColgan 2006;
Woolham 2005). One way to accomplish this is to develop
effective service delivery options in independent and semi-
independent settings and avoid moving consumers to more
restrictive and costly living arrangements. A possible prereq-
uisite to delivering effective services in these desired settings
is determining which factors are responsible for preventing
independent living.
Factors Contributing to Decisions Regarding Living
Arrangements
Identifying barriers that prevent seniors and individuals with
disabilities from independent and semi-independent living
may help consumers and service providers plan appropriate
supports and services in the least restrictive environment. A
number of variables may contribute to decisions about where
an individual resides and the types of supports received. For
example, researchers have identified several
sociodemographic factors that influence health outcomes,
generally (Emerson et al. 2006; Williams 1983); however,
the literature explicitly linking sociodemographic factors as
barriers to independent living is limited. Lowe Worobey and
Angel (1990) evaluated level of functioning, race, social class,
and gender related to choices to remain living alone or
transitioning to a group or an institutional setting. They found
that despite decreasing level of functioning, women, individ-
uals who were more financially stable, and Caucasians were
more likely to continue to live alone. Other sociodemographic
factors play a role as well. Female gender, advanced age, and
race are associated with a lower functioning level in individ-
uals with disabilities (e.g., DeJong and Branch 1982; Dunn
1990). An obvious barrier for individuals who are
economically disadvantaged is the cost of services. Together,
these findings suggest that socioeconomic factors influence
the prevalence of the need for health care services.
Additional variables may influence the degree to which an
individual lives independently including level of functioning
and geographic variation. Yeager (1996) determined that com-
munication skills, a reliance on others, disorientation (i.e.,
lacking knowledge about time, place, or person), and a need
for support beyond that required to assist with daily living
affects ones probability of living independently. Individuals
71
who are unable to complete daily living activities, such as
planning and preparing meals, cleaning, maintaining personal
hygiene, using minor first aid, and upholding financial respon-
sibilities might be unable to live in an independent environ-
ment (Wister 1985). Decisions about where to live may be
affected by geographic location since the types and quality of
care options and service providers vary in different commu-
nities and regions (Baicker et al. 2005). Individuals who reside
near metropolitan areas may have more options available to
them than those who live in rural communities with few
service providers and limited access (Arcury et al. 2005).
Moreover, spending on healthcare and services varies as a
function of state and county (McAneny, n.d.). In their analysis
of geographic variation, Baicker et al. (2005) documented
differences in effective care for Medicare enrollees as a func-
tion of where in the USA services were provided (e.g., a
greater proportion of enrollees living in the northeast receive
effective care than those residing in the southeast). These data
suggest that the types and quality of service providers vary by
location, which may restrict or expand living options available
to consumers.
Personal views may serve as another factor potentially
affecting decisions about where to reside. Although we were
unable to locate any studies that directly asked consumers and
care providers about the variables that serve as barriers to
independent living, there are at least two studies that queried
consumers about their views on changes in residence. Jungers
(2010) interviewed aging individuals about their attitudes
related to transitioning from their home to a less independent
setting and reported that many individuals moving into an
assisted living facility experienced loneliness as well as a loss
of independence and autonomy. Accordingly, personal views
regarding the desire or ability to maintain old friendships,
develop new friendships, and retain autonomy may influence
the decision to transition to a care facility or other living
environment. Negative perceptions and stigma associated
with receiving assistance, particularly assistance that requires
a change in residence, may also influence decisions. Despite
fears expressed by seniors regarding a loss of autonomy and
restrictions associated with assisted living facilities (Jungers
2010), individuals with intellectual or developmental disabil-
ities report an increase in independence as a primary reason
for moving from their caregivers home to a care facility
(Cattermole et al. 1988). Finally, a desire to avoid placing
burden on family members may increase the likelihood of
moving to a care facility (Jungers 2010).
Purpose of the Present Study
The literature on factors associated with independent living is
limited and requires readers to draw inferences about what
variables may constitute actual barriers. We were unable to
72
locate a study asking consumers, caregivers, or service pro-
viders about the variables that serve as barriers to independent
living. Thus, the purpose of the present study was to address
this gap in the literature and ask consumers and other key
stakeholders to identify barriers and rate their importance to
independent living. This study involved senior citizens and
individuals with disabilities so that we could compare and
contrast the findings of the two groups of service recipients.
Identifying and summarizing similarities and differences
across the two groups may help to individualize life-
planning and transition decisions as well as plan appropriately
for services.
Method
Participants
Participants in this study were senior citizens, paid staff (e.g.,
professionals, paraprofessionals, advocates), and family mem-
bers (e.g., parents, siblings, children) of individuals with dis-
abilities and senior citizens who responded to an invitation to
complete an online anonymous survey distributed by their
employers, professional organizations, or other member
groups. Per institutional review board requirements, institu-
tions were not asked to inform us about whether they distrib-
uted the survey link and/or the number of individuals to whom
they sent the link. As a result, we are unable to calculate a
response rate. One hundred and fifty three individuals opened
the survey link, and only one individual declined participa-
tion. Thus, 99.3 % (n=152) of individuals who opened the
survey via the survey link elected to participate in the survey.
Instrumentation
To assess barriers to independent living, we developed an
online survey consisting of three sections. The first section
asked participants to provide demographic information in-
cluding the following: (a) role (family member [of an individ-
ual with a disability or a senior citizen], professional/staff/
advocate [of an individual with a disability or a senior citizen],
elderly/senior, other); (b) present living environment of family
member, if applicable; (c) age of family member, if applicable;
(d) years of experience for professional/staff/advocate; (e)
highest degree obtained for professional/staff advocate; and
(f) age for elderly/senior respondents. The next section of the
survey asked participants to review a list of considerations and
indicate whether these served as barriers to independent living
(yes=barrier, no=not a barrier). The considerations included
(a) medical condition (e.g., heart condition, diabetes, eye
problems, breathing difficulties); (b) mobility difficulties
(e.g., risk of falls, walking assistance); (c) assistance with
taking medications independently; (d) memory loss,
Behav Analysis Practice (2014) 7:7077
disorientation; (e) incontinence; (f) dual diagnosis (e.g., psy-
chiatric disorder, behavior disorder, intellectual disorder); (g)
severe weather safety; (h) fire safety; (i) assistance with house-
hold skills (e.g., cooking, cleaning); (j) assistance with daily
living skills (e.g., bathing, brushing teeth, dressing); (k) per-
sonal safety (e.g., intruders, stranger danger, self-protection
from roommates); (l) running or wandering from home; and
(m) loneliness. The final section of the survey asked partici-
pants to rate the importance of these 13 considerations using a
four-point Likert-type scale (1=not important, 2=somewhat
important, 3=important, 4=very important).
Procedure
Before conducting the survey, we obtained approval from the
governing Human Subjects Committee (i.e., Institutional Re-
view Board). The survey link was sent via electronic mail to
13 institutions in Kansas and Missouri that served or provided
resources to senior citizens, individuals with disabilities, or
family members of senior citizens or individuals with disabil-
ities (e.g., area departments on aging, independent living
centers). We focused on distributing our survey to institutions
in the central USA because the rate of effective care for
Medicare enrollees is within the middle range (43.5 to
48.3 %) and not in the low (30.2 %) or high (56.9 %) ends
of the continuum (Baicker et al. 2005). Effective care refers to
the delivery of care or services that show evidence of reduced
risks of relevant and important clinical outcomes, such as
disease or injury (Munson et al. 2013). In an attempt to
increase the generality of our findings, we avoided surveying
respondents who lived in geographic areas with particularly
low or high rates of effective care. Institutions were asked to
disseminate an invitation containing the survey link to their
employees, clients, or other contacts via electronic mail cor-
respondence. We invited institutions to assist with the dissem-
ination of the survey one time only.
Results
Demographic Characteristics of the Sample
One hundred fifty two individuals agreed to complete the
survey. A majority of respondents identified themselves as a
disability professional/staff/advocate (40.4 %) or a caregiver/
parent/family member of an individual with a disability
(29.1 %). Administrators and clinicians/practitioners/man-
agers/social workers comprised nearly half of the disability
professionals. Parents comprised a large majority of the family
members of individuals with disabilities (n=31 of 44 respon-
dents). Respondents who worked as paid professionals or staff
had a wide range of years of experience and degrees. Forty-
Behav Analysis Practice (2014) 7:7077 73

one percent of disability professionals had 16 or more years of Table 2 Experience and
education of paid profes- n %
experience and held a bachelors degree. Conversely, 40 % of
sionals or staff
professionals in the gerontology field who responded to our Gerontology fieldyears of experience
survey had 0 to 5 years of experience. A majority of these 05 6 40.0
individuals had bachelors (60 %) or masters (20 %) degrees. 610 3 20.0
A small percentage of our sample identified themselves as 1115 0 0.0
senior citizens (2.0 %) or working with or related to a senior 16+ 5 33.3
citizen (staff or advocate=9.9 %; caregiver, parent, or family Did not specify 1 6.7
member=8.6 %). Tables 1 (demographic characteristics) and Gerontology fieldhighest degree
2 (experience and education of paid professionals and staff) obtained
summarize these data in more detail. Registered nurse 1 6.7
Tables 3 and 4 summarize the living arrangements reported Bachelors 9 60.0
by family members of individuals with disabilities and senior Masters 3 20.0
citizens, respectively. Most individuals with disabilities were Doctorate 1 6.7
reported to reside in the home of the respondent (40.5 %) and Did not specify 1 6.7
were 31 years old, on average. A large majority of senior Disability fieldyears of experience
citizens were reported to live independently in their own home High school 10 16.4
or apartment without staff present (66.7 %). The average age Associate 4 6.6
of the senior citizens was 72 years old. License practical nurse 1 1.6
Bachelors 25 41.0
Table 1 Demographic characteristics of respondents Masters 11 18.0
Doctorate 3 4.9
n % Did not specify 7 11.5

Caregiver/parent/family member of a senior citizen 13 8.6

Parent 1 Endorsed Barriers
Child 7
Other 2 Table 5 depicts the percentage and frequency of respondents
Did not specify 3 who endorsed the considerations as barriers to independent
Caregiver/parent/family member of a person with a disability 44 29.1 living, separated by group (individuals with disabilities, senior
Parent 31 citizens). Approximately 98 respondents completed each sur-
Grandparent 1 vey item (individuals with disabilities=37 or 38, senior
Sibling 6
Other 5
Table 3 Frequency and percentage of respondents specifying the living
Did not specify 1 arrangements of a person with a disability
Disability professional/staff/advocate 61 40.4
Direct service professional 8 n %
Administrator 15 Respondents home 17 40.5
Licensed practical nurse 1 Independently in his/her own home/apartment 1 2.4
Registered nurse 1 with no staff supports
Clinical/practitioner/manager/social worker 14 Foster care (adult or child) 2 4.8
Other 16 Supported living in a home/apartment with 9 21.4
three or fewer persons
Did not specify 6
Group home with support and four to eight 1 2.4
Gerontology professional/staff advocate 15 9.9 individuals living together
Direct service professional 2 Residential facility with nine or more people 8 19.0
Administrator 1 Nursing care (skilled nursing or nursing home) 1 2.4
Registered nurse 1 Other (specify): 5 11.9
Clinical/practitioner/manager/social worker 4 Family teaching model home 1
Other 7 Apartment with visiting support staff twice a day 1
Senior citizen/elderly 3 2.0 Community facility 1
Other 15 9.9 Supported living center 1
Did not specify 1 0.7 ICF/MR/DD 1
74 Behav Analysis Practice (2014) 7:7077

Table 4 Frequency and percentage of respondents specifying the living
arrangements of a senior citizen
n %
Respondents home 0 0
Independently in his/her own home/apartment 6 66.7
with no staff supports
Assisted living 2 22.2
Nursing care (skilled nursing or nursing home) 0 0
Other (specify): 2 11.1
Own home with minimal support staff 1
Own apartment with visiting support staff 1
citizens=59 or 60). For individuals with disabilities, the top
three considerations endorsed as barriers were personal safety
(94.7 %), assistance with household skills (94.7 %), and
assistance with medication (89.5 %). For senior citizens, en-
tirely different considerations were endorsed as the top bar-
riers and included memory loss and/or disorientation
(95.0 %), mobility difficulties (90.0 %), and running or wan-
dering away (81.7 %).
Importance Ratings
Respondents were also asked to rate the importance to inde-
pendent living of each of the considerations using a Likert-
type scale (1=not important, 2=somewhat important, 3=
important, 4=very important). Table 6 shows the mean rating
of importance separated by group (individuals with disabil-
ities, senior citizens). With the exception of one consideration
(assistance with household skills), approximately 98 individ-
uals completed each of the considerations on this section of
the survey. For individuals with disabilities, the top three mean
ratings were personal safety (M=3.71), assistance with house-
hold skills (M=3.65), and assistance with medications (M=
3.63). These considerations and the order of importance are
identical to those the same group of respondents endorsed as
barriers. For senior citizens, the top three mean ratings were
memory loss and/or disorientation (M=3.37), running or wan-
dering away (M=3.25), and assistance with medications (M=
3.23). The same group of respondents also endorsed two of
these considerations as barriers. Both groups of respondents
(i.e., for individuals of disabilities and senior citizens) rated
assistance with medications as one of the most important
considerations.
An independent sample t test was conducted to compare
importance ratings of each of the 13 considerations for the two
groups: individuals with disabilities or senior citizens. There
was not a significant difference in the ratings for three of the
13 considerations: dual diagnosis (t(93)=0.4426, p=0.6591),
loneliness (t(94) = 0.9408, p = 0.3492), and incontinence
(t(93)=0.5731, p=0.5680). The differences in the importance
ratings were significant for the remaining 10 considerations at
the p<0.05 (n=4), p<0.01 (n=2), and p<0.001 (n=4) values
(see Table 6). These results suggest that respondents provided
significantly different ratings of importance for a clear major-
ity of the considerations depending on whether the consider-
ations were about an individual with a disability or a senior
citizen.

Table 5 Percentage (frequency) of respondents indicating the consider- Discussion

ation serves as a barrier to independent living (separated by group)

Individuals with Senior The purpose of the present study was to identify variables that
disabilities citizens serve as barriers to independent living for individuals with
% (n) % (n) disabilities and senior citizens. Additionally, we were interest-
ed in assessing the importance of each variable. The top three
Personal safety 94.7 (36) 70.0 (42)
barriers for individuals with disabilities center on safety and
Assistance with household skills 94.7 (36) 63.3 (38)
skill deficits (i.e., personal safety, household skills, and med-
Assistance with medications 89.5 (34) 76.7 (46)
ication assistance). Respondents also rated these barriers as
Assistance with daily living skills 76.3 (29) 70.0 (42)
the most important, which shows convergent evidence for
Fire safety 86.8 (33) 61.0 (36)
their relevance as potential barriers to independent living.
Dual diagnosis 68.4 (26) 76.7 (46)
The top three barriers identified for senior citizens and rated
Loneliness 72.9 (27) 58.3 (35) as most important center on issues that are largely medical/
Running or wandering 55.3 (21) 81.7 (49) organic (i.e., memory loss/disorientation, wandering, and
away
Severe weather safety 67.6 (25) 41.7 (25) medication assistance). Overall, the present findings suggest
Medical condition 52.6 (20) 70.0 (42) that the barriers to independent living are unique to the re-
Mobility difficulties 47.4 (18) 90.0 (54) spective populations, which has important implications for
Memory loss/disorientation 47.4 (18) 95.0 (57)
practice as well as future research.
Incontinence 40.5 (15) 52.5 (59)
The current results add to the independent living literature
in a number of ways. First, the current study evaluated the
Bold font denotes top three barriers for each group of respondents responses of individuals who receive services, care for a loved
Behav Analysis Practice (2014) 7:7077 75

Table 6 Mean rating (standard

deviation, frequency) of Individuals with disabilities Senior citizens p value
importance to independent living M (SD, n) M (SD, n)
(separated by group)
Personal safety 3.71 (0.65, 38) 3.05 (0.96, 60) 0.0003***
Assistance with household skills 3.65 (0.54, 74) 2.77 (0.85, 60) 0.0001***
Assistance with medications 3.63 (0.75, 38) 3.23 (0.89, 60) 0.0236
Assistance with daily living skills 3.51 (0.87, 37) 2.88 (0.87, 60) 0.0008***
Fire safety 3.41 (0.87, 37) 2.73 (1.06, 59) 0.0014**
Dual diagnosis 2.97 (1.28, 37) 3.07 (0.92, 58) 0.6591
Loneliness 2.81 (0.92, 36) 2.63 (0.90, 60) 0.3492
Running or wandering away 2.76 (1.30, 38) 3.25 (0.76, 59) 0.0212*
Severe weather safety 2.75 (1.13, 36) 2.27 (1.08, 59) 0.0417*
Medical condition 2.68 (1.33, 37) 3.21 (1.01, 58) 0.0302*
Bold font denotes top three rat- Mobility difficulties 2.51 (1.26, 37) 3.13 (0.91, 60) 0.0061**
ings for each group of Memory loss/disorientation 2.35 (1.21, 37) 3.37 (0.76, 59) 0.0001***
respondents
Incontinence 2.22 (1.27, 36) 2.36 (1.08, 59) 0.5680
*p<0.05, **p<0.01, ***p<0.001

one, or provide services to individuals with disabilities or
senior citizens. Previous literature is largely speculative and
requires readers to draw inferences about which factors serve
as barriers to independent living (e.g., Hazen and McCree
2001; Jungers 2010; Yeager 1996). Querying key stakeholders
provides an important contribution and addresses a glaring
gap in the literature. Without identifying the factors that actu-
ally serve as barriers, it is impossible to optimize supports and
target skills to increase independent living. Although we did
not supplement our findings with in-home assessments to
determine the accuracy of respondent reports, the results pro-
vide a better understanding of important considerations. Sec-
ond, the current study examined the responses of two groups
of service recipients and reported their data separately. The
data suggest that the reported barriers are distinct to each
group underscoring the importance of individualized plan-
ning. If we had aggregated the data across the two groups,
our findings may misrepresent specific barriers and needs of
each individual group. These results may help to identify the
supports or conditions necessary for an individual to continue
to live independently and may inform decisions about the
skills that could be targeted, which may reduce costs associ-
ated with providing unnecessary services or transitioning to
different or more restrictive living arrangements. A difference
in barriers across the two groups emphasizes the need for
individualized, tailored solutions. Third, information about
which variables serve as barriers to independent living may
allow us to target the relevant barriers sooner, thereby (1)
reducing lengthy waitlists, (2) creating opportunities to serve
people longer in their own homes, and (3) possibly minimiz-
ing abrupt transitions to more restrictive settings.
Accomplishing these may also improve the quality of life for
individuals with disabilities and senior citizens by increasing
independence and autonomy in targeted areas that they value.
Previous research indicates that independent and semi-
independent settings are associated with better outcomes,
lower costs, and greater choice (Burchard et al. 1991;
Stancliffe et al. 2011; Stancliffe and Keane 2000) suggesting
that there are benefits to addressing potential barriers. Many of
the above-mentioned outcomes are speculative; thus, addi-
tional research is needed to document conclusively that these
outcomes are obtained.
Implications for Behavior Analysts
These findings have important implications for behavior ana-
lysts with respect to optimizing environmental supports for
and addressing particular skill deficits of individuals with
disabilities and senior citizens.
1. Most notably, the results identify barriers to independent
living that are unique to each group assessed suggesting a
need for service providers and policy makers to tailor
interventions, provision of resources, and changes in pol-
icy appropriate to the barriers experienced by that partic-
ular population. The differences in reported barriers
across groups underscore the importance of ongoing,
individualized assessment in order to address the specific
needs of service recipients. Although behavior analysts
may be well aware of the limitations associated with a
one-size-fits-all approach, traditional congregate care set-
tings and large nursing facilities are often ill-equipped to
tailor interventions based on individual need. These data
provide further evidence of the necessity for high-quality
behavior analytic services (e.g., assessment and interven-
tion). With respect to convergent patterns regarding the
top-reported barriers and their importance within a group,
these commonalities might be a first step toward identi-
fying indicated interventions or living solutions unique to
a particular service recipient group.
76
2. The barriers identified for individuals with disabilities
included safety and skill deficits, two areas that may
benefit from targeted skills training. There is a great deal
of behavior analytic research demonstrating the effective-
ness of available methods to teach self-help and safety
skills (e.g., Bannerman et al. 1991; Batu et al. 2004;
Taylor et al. 2004; Winterling et al. 1992). We recommend
that practitioners consult previous research to guide their
intervention efforts and focus on training the necessary
skills and safety behaviors that improve an individuals
ability to live independently, as appropriate.
3. The barriers identified for senior citizens included factors
that are likely not able to be remedied through skills
training, which suggests the necessity for ongoing assis-
tance and monitoring. Advancements in smart home tech-
nology offer unique solutions to accomplishing this goal
without moving individuals from their home to restrictive
settings with round-the-clock staffing. These advance-
ments may be relevant for both senior citizens and indi-
viduals with disabilities interested in living in an indepen-
dent or semi-independent setting. To address a top con-
cern reported for senior citizens regarding wandering or
running away, homes may be equipped with specific
sensors to allow service providers to detect when a service
recipient has passed the threshold of a door. That is,
technology allows us to equip homes with sensors so that
service providers are informed when a need arises (e.g., a
service recipient has sustained a fall; a stovetop burner is
on for a sustained period). These types of passive or self-
directed monitoring agents provide comfort to consumers
and families because they signal when assistance is need-
ed without the need for onsite staff or a move to a more
restrictive setting. Moreover, advanced smart home tech-
nology can be designed so that it is easily accessed by
service recipients when needed (see DiGennaro Reed and
Reed 2013 for a description of one application of this
technology). These types of services may offer alterna-
tives to senior citizens and individuals with disabilities
and simultaneously alleviate the financial burdens associ-
ated with care. When assisting consumers in making life
planning and transition decisions, practitioners might con-
sider options made available through these types of tech-
nological advancements.
Limitations and Future Research
Although this study may serve as a helpful starting point for
evaluating barriers to independent living, a number of limita-
tions exist that warrant discussion and suggest areas for future
research. First, given the number of respondents and the
geographic region surveyed, this sample may not be represen-
tative of the needs of individuals across the USA. We
Behav Analysis Practice (2014) 7:7077
encourage readers to exercise caution when interpreting our
findings since the representativeness of our sample is un-
known, which is a threat to the external validity of our results.
Future research could expand on these data by disseminating
the survey across settings and geographic regions in order to
obtain a nationally representative sample. Next, the survey
items were conceptually derived and created with the best
available evidence from the literature at the time; however,
the survey likely has not captured all of the relevant concerns
individuals face when choosing a living arrangement. Addi-
tionally, in the demographic portion of the survey, respondents
were required to select one of two dichotomous groups: dis-
ability or senior citizen. The study does not account for a
portion of the population with disabilities who are aging or
individuals who age into disability. Considerations that serve
as barriers are unknown for this subset of the population and
may differ from those identified in our findings. Future re-
search should address this limitation. Importantly, due to
restrictions by the institutional review board, we were unable
to query individuals with disabilities about potential barriers.
Additional research might identify ethical and accurate means
of obtaining responses from this population. Ultimately, these
findings highlight the need to learn more about the factors that
prevent independent living in order to increase the options
available to individuals with disabilities and senior citizens
and maximize their independence.
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